Responsible Antibiosis in Patients Presenting Acutely with Midface Fractures
Charles C. Jehle, Jr., M.D., Marten N. Basta, M.D., Damon McIntire, B.A., Albert S. Woo, M.D..
Brown University at Rhode Island Hospital, Providence, RI, USA.
Responsible antibiosis has increasingly become an important issue as it pertains to clinical and economic impact on patient care. Safely limiting the use of prophylactic antibiotics when they are not indicated is both good practice and can improve patient safety.METHODS: A retrospective review of all patients presenting to our hospital with isolated midface fractures from 1/1/16 to 6/30/17 was conducted. Patient demographics, characteristics of patients' fractures, surgical intervention, prescription of antibiotics as well as presentation with infection were reviewed. Logistic regression of patient demographics, fracture type and prescription of antibiotics identified risk factors for infection.
RESULTS: Of 597 patients identified, 49.7% were prescribed an antibiotic and 18 patients re-presented with an infection. Interestingly, 8 of these were infections of the face while 10 were pneumonia. Risk factors of contracting any infection after a midface fracture were male gender (OR=4.11 p=0.05), receiving any antibiotic (OR=8.17; p=0.001). Being under age 30 leads to statistically decreased risk (OR=0.20, p=0.036) of infection. The only statistically significant risk factor for contracting an infection of the face was receiving antibiosis (OR=12.00; p=0.021).
Midface fractures are inconsistently treated with antibiotics as there is concern the fractured bone may be exposed to sinus, nasal or oral mucosa. In our patient population it seems that receiving antibiotics is a risk factor for developing an infection, most commonly pneumonia. This suggests that isolated midface fractures should not be managed with prophylactic antibiotics and may expose the patient to undue risks or opportunistic infection.
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